Interview by Frances Mei Hardin, MD

Amna Shabbir, MD, is a lifelong high achiever. She is a self-described perfectionist, who completed her medical training at several prestigious institutions such as the Cleveland Clinic and Duke University. She is now living her most authentic life as a part-time geriatrician, a physician coach, and mom. On the wall behind her desk hangs the quote by George Bernard Shaw, “Life isn’t about finding yourself. Life is about creating yourself.” She has taken stock of her life, gotten off the conveyor belt so many physicians stay on, and created the life she wants.

I: Thank you so much for joining me today. I’m grateful that you’re so willing to share your wisdom with early career physicians and young physicians in training. Can you start with an overview of your residency and fellowship experience?

A.S.: Absolutely! Glad to be here. I have always been interested in internal medicine and primary care; when I went to Cleveland Clinic for my residency I completed the primary care track. Overall, it was a wonderful experience and the program was really supportive. I went out to work as a primary care physician and burned out within the first three months. I was in denial about being burned out, of course, and did not want to accept the fact that I felt signs of burnout at the time.

I: That must have been so difficult, to be only three months into your attending practice – the culmination of so many years of dedicated work – to start noticing signs of burnout. What was your daily practice like at that time?

A.S.: The way the healthcare system is structured, primary care physicians can never win – we need to see as many patients as possible, squeezing every visit (including complex issues) into 15-20 minute visits. That took time away from my family and my self-care, to provide the care that our patients needed.

I: When you started to notice signs of burnout, what did you think was going on?

A.S.: I didn’t have the insight at the time to know it was really burnout. I thought something was wrong with me, other people around me were not sharing that they’re having issues. So I really internalized those feelings as being something wrong with me, despite the objective facts: that I was one of the primary care providers in the system with very high patient satisfaction scores, my patients loved me, and I was providing high-quality evidence-based care.

I: It is funny how in hindsight we can see times when our thoughts, or the narratives we told ourselves, were not in alignment with the objective facts of the situation. Burn out contributes to that mismatch too, I think.

What happened next with your first attending job?

A.S.: I continued to work at the same position for almost 4 years. I was an international medical graduate, had worked so hard to go to UCLA and Harvard for clinical and research opportunities prior to residency training, and I was a perfectionist. I worked hard, provided excellent care for my patients, but eventually I hit a crisis moment.

I finally had a moment of clarity and needed to pause, because I could see that everything I was doing was not producing the results that I wanted in my life. One day, in the middle of clinic, I broke down crying. Of course, I collected myself and still saw the rest of my patients on the schedule that day, but it was the day that I knew things seriously had to change.

When I took stock of my practice and what I wanted out of a career, I realized that I loved taking care of older adults. It was so rewarding to care for them and spiritually fulfilling to work with their families.

I: That’s incredible! Many physicians keep their head down and work – we are a resilient population – until a sentinel event “wakes them up” in a sense, and starts to open up other paths. Often by necessity. Once you decided that you wanted to focus on geriatrics, what did that pivot look like?

A.S.: I started a geriatrics fellowship, the core requirements are completed in 1 year but I positioned myself to aim for the  3-year track in aspirations I would be on track to be in a future leadership position in a prestigious academic environment.

I: 3 years! I already believed you when you said you were an overachiever, but now I really see it. How was your fellowship experience?

A.S.: I was still in the mode of “work more, be more perfect, give give give.” One night I asked my husband at dinner, “What if I leave?” His earnest reply was, “Yes, please – I will pay you. We will adjust as necessary.” He didn’t want to be the one to tell me to pause my career as a successful, driven female minority – he had wanted me to come to the realization myself. I was at the point where I had nothing left to give, and considered leaving clinical medicine altogether.

I: Our partners often see these things before we even do. I’m glad he was on board with a change in plans, though, because having support during any career transition is crucial. How was the experience of making that decision, to go from the 3 year to the 1 year track? How did the program take the news?

A.S.: It was so hard. It felt like a death; I went through the bereavement process for months. I had never “given up” on anything in my life, and it was very difficult to let it go. Of course, the program took it well, they said it wasn’t a problem at all. It was all my internal dialogue reminding me how massively I had failed. 

I: There are a lot of situations where we as physicians beat ourselves up for a change in course, or a shift from our predetermined plan, even with a host of support from family, institution, and so forth.

And it is interesting that you describe that time in your life as a bereavement process. It was an identity death.

A.S.: Exactly. It felt like I was letting everyone down. I found it very hard to say no to anything! The decision to no longer be tied to an academic institution felt like a failure on my part, especially as an IMG. Every day for several months following, I would park my car and cry, either at the beginning or end of the day.

Regarding the identity death: you have to tear yourself down to recreate yourself. Active deconstruction needed to happen to create an identity more aligned with myself and my values.

I: I love that and I fully agree. It’s incredibly intimidating for any physician or physician in training to do that, however, in part because of phenomena like the sunk cost and arrival fallacies.

After fellowship, what was next in your journey?

A.S.: I took a few months-long sabbatical after fellowship. After finishing, I was still feeling very burnt out. I knew that I had to be very intentional with my next job and creating my schedule at that job. I only saw myself doing clinical medicine part-time, and in doing so that would allow me to show up 100% for my patients on the days that I worked.

I had always had great interest in positive psychology (since reading the 7 Habits Of Highly Effective Teens at 13 years old) and my mom had told me to do medicine first, then I could do whatever I wanted. I guess it was finally my time! I wanted to become a coach and help other physicians – to help “me,” a young person who was successful, had done well academically, but needed to learn how to stop being an extreme giver and to hold something back for themselves. I founded the Early Career Physician Institute in 2023.

I: It’s incredible that you truly took the time to determine what the right clinical schedule looked like for you, and then you made it happen. It sounds really intimidating to do so but clearly you are an illustration that while it can be more discomfort up front, that step is necessary to build the life of your dreams.

And I am always moved when someone’s own journey in medicine spurs them to then go out and provide resources, coaching, support, for the next generation.

Thank you for your candor and sharing your story. To finish with a few pearls of wisdom, what do you think are the most common mistakes people make when taking their first jobs?

A.S.:

1.    “Pick me” energy. When residents are applying for their first jobs they have a “pick me” energy that they took into medical school and residency as well. Recognize that your first attending job is different – it’s not the same as “being selected” or admitted for a training program.

2.    They don’t know their needs. Take time to recognize your needs as a human. A 360 analysis of what you need and want in life. If at all possible, take time off between residency and your first job, and try to completely disconnect.

3.    They don’t know their self-worth. By the time of residency completion they have 12,000-16,000 hours of clinical training under their belts. It’s important to remember your abilities and self-worth. Write down all the amazing things you’ve done – you didn’t just “happen to get there,” don’t go to an institution with a desperate energy just to get picked.

4.    They don’t realize how much agency they have. How can you use your choices and recognize your own needs to enter a space where you can then advocate for your needs. If you haven’t done the work and don’t know your needs, how can you negotiate for them?

5.    When there’s a mismatch, they assume it’s a problem with them. Just know that even if you do your best, there’s almost a 50% likelihood that your first job is a mismatch, and you won’t stay there. That doesn’t mean there’s anything wrong with you inherently. If it happens, then look for the next opportunity.

I: What are red flags that people should look out for while searching for their first job out of residency?

A.S.:

1.    Intuition. If you walk into a space, and have a bad feeling, don’t ignore it. Throughout our medical training we are trained to have a mind-body disconnect; it’s a critical time to listen to your intuition again.

2.    Dictatorial style of communication. If the hospital or practice continues to tell you things rather than approach the interview process in a collaborative, inviting manner, and trying to be flexible – pause and reconsider.

3.    Physician and provider turnover. If people are coming and leaving, admin probably doesn’t care about you.

I: Do you have any favorite quotes to share today?

A.S.: I have always loved quotes but I realized that all the quotes I had saved during my medical training and as an early career physician were geared towards the idea that we should work ourselves to exhaustion and never quit. An example of one of my old quotes I had saved was an excerpt from Good Timber by David Malloch:

“The tree that never had to fight

For sun and sky and air and light,
But stood out in the open plain
And always got its share of rain,
Never became a forest king
But lived and died a scrubby thing.

Good timber does not grow with ease:
The stronger wind, the stronger trees”

So, I realized I needed to get some new quotes. One of my new favorites is from Anais Nin:

“And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom. Life is a process of becoming, a combination of states we have to go through. Where people fail is that they wish to elect a state and remain in it. This is a kind of death.”

Amna Shabbir MD, CPC is passionate about helping doctors thrive in life after medical training as an early career physician. She is the Founder of Early Career Physicians Institute, a Certified Wellness and Life Coach, Dual Board-certified Geriatrician-Internist and Super Mom to two young girls.